| NPI | 1881640233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 4768) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 30920) |
| 202K00000X (Licence: SD 4768) | |
| 207Q00000X Family Medicine (Licence: MN 51491) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2021-09-29 |